was this an 'accident'? help with health insurance form

February 6, 2024 8:22 AM

I tripped and fell in my own home wearing the wrong shoes while carrying something and sprained my ankle. Got an x-ray, sent to PT, etc. Now my health insurance has sent a 'coordination of benefits' form asking if this was an accident and if there is another at-fault party. How should I fill out this form?

I want to make sure they cover this claim and do not try to bill my homeowner's insurance. There is a box to 'check if injury not accident related' - is that the right field? What happens if I don't return the form? Please help me make sure these claims get paid with a minimum of hassle. I am afraid of ending up in endless bureaucratic health insurance claim hell.

posted by epanalepsis to Work & Money (9 answers total)

This happened to us once when my husband’s axe slipped (he was fine). Our sense was they were interested in knowing if there was another party involved or if the accident happened on the job, not to coordinate with our homeowners. I’d fill it in and check no and not worry about it.
posted by Sweetie Darling at 8:33 AM on February 6, 2024 [3 favorites]

Your answer is "not accident related" here. It's only "yes" when someone else's insurance might be at fault - like someone crashed their car into you, or if you did this at work, where worker's comp might have to get involved.
posted by BlahLaLa at 8:35 AM on February 6, 2024 [16 favorites]

This also happened to me when my big oaf of a dog dislocated my knee. My health insurance company wanted to make sure that there wasn't someone else's big oaf of a dog who could be blamed, but I checked the box for "nope" and they went on their merry way and paid my claims like normal.
posted by fancypants at 8:36 AM on February 6, 2024 [3 favorites]

Your health insurance is trying to see if some other 3rd party should step in and share or take over the burden of paying out your claim. If this were an accident at work there would be Workers' Comp insurance involved. If you did this at a friends house, their homeowners'/umbrella insurance might be in involved. If it were at a public park, perhaps your city's liability insurance would be involved.

But, since this was you in your own home, there is no one else but your own insurance to handle this. So, check this box.

I will say, that most insurances (like Kaiser for example) make this question significantly more clear.
posted by Back At It Again At Krispy Kreme at 8:39 AM on February 6, 2024 [2 favorites]

This question almost always means “was another vehicle involved?” If not, say no.
posted by Thorzdad at 9:38 AM on February 6, 2024

Best answer: It's called subrogation. They are trying to pass the buck off so they don't have to pay out. Just say nope and send it back. Or ignore it and they will send about five more letters asking the same thing. Not that I would know anything about that.
posted by dancinglamb at 9:52 AM on February 6, 2024 [2 favorites]

It was an accident, but it's a health acre issue. They'd like to get your homeowner's insurance to pay. I fell while X-C skiing, and did not supply the name of the small-time ski location. I like dancinglamb's approach.
posted by theora55 at 10:26 AM on February 6, 2024

my insurance does this too. I always say "no" because I don't want my greaseball insurance to try to sue the school or my neighbor. If it was a car accident I'd probably check yes .
posted by Dr. Twist at 10:58 AM on February 6, 2024

Response by poster: Follow-up: I replied no and never heard anything else about it. Thanks all.
posted by epanalepsis at 7:19 AM on April 17, 2024